Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

Abstract

The incidence and mortality of colorectal carcinoma are rising in young adults. This population‐based propensity matching study aimed to compare long‐term oncological outcomes of local excision with radical resection for early localized colorectal cancer (CRC) in young patients without preoperative chemoradiotherapy. Patients under 45 years old with T1 colon or rectal adenocarcinoma who underwent local excision or radical resection were included from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2014. Survival curves were plotted using the Kaplan–Meier method. Cancer‐specific survival (CSS) was compared using adjusted hazard ratios (HRs) between local excision and radical resection. After propensity score matching procedure, total of 1719 patients were included in the analysis, among which 573 treated with local excision and 1146 treated with radical resection. The median follow‐up was 80 months (interquartile range(IQR): 37–132), with 1074 patients followed for ≥5 years and 508 patients followed for ≥10 years. Five‐year CSS of local excision versus radical resection was 93.4% versus 96.7% for colon cancer and 96.6% versus 98.4% for rectal cancer. Ten‐year CSS of local excision versus radical resection was 91.4% versus 94.0% for colon cancer and 92.8% versus 96.7% for rectal cancer. On multivariable analysis, compared with radical resection, local excision was not associated with inferior CSS for colon (HR 1.74, 95% CI: 0.92–3.29, P = 0.090) and rectal cancer (HR 2.16, 95% CI: 0.99–4.71, P = 0.052). There is no evidence of differential long‐term oncological outcomes between local excision and radical resection. These findings supported clinical application of local excision for early colon and rectal cancer in young adults.

Clinical predictors of pathological good response in locally advanced rectal cancer

“…With the development of surgical technology, patients with early rectal cancer who underwent LE were found to have no significant difference in survival compared with those treated with TME [ 18 , 19 ]. This finding was also confirmed in patients with LARC who responded well to nCRT [ 8 – 10 ].…”

Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

“…A population-based propensity matching study on 1719 patients with CRC at <45 years compared the outcomes of endoscopic vs surgical treatment (573 and 1146 patients, respectively). 203 For colon cancer, there was no statistically significant difference in the 5-year and 10-year cancer-specific survival (93.4% vs 96.7% and 91.4% vs 94.0%, respectively; P ¼ .149). 203 For rectal cancer, there was no statistically significant difference in the 5-year and 10-year cancer-specific survival (96…”

“…203 For colon cancer, there was no statistically significant difference in the 5-year and 10-year cancer-specific survival (93.4% vs 96.7% and 91.4% vs 94.0%, respectively; P ¼ .149). 203 For rectal cancer, there was no statistically significant difference in the 5-year and 10-year cancer-specific survival (96…”

Incidence of Colorectal carcinoma in Young Population of Islamabad

“…Colonoscopy is the best investigation to detect the early neoplastic changes and even if a polyp is seen on colonoscopy it is removed at the same time [26,27]. Unfortunately in Pakistan screening is not done as a routine investigation, particularly in rural areas because of illiteracy and lack of access to health care centre and even in urban areas due to lack of awareness patients reach the health care centres in late stages [28][29][30][31][32][33][34][35][36][37][38][39]. Even when patient go to a hospital with symptoms of bowel disease colonoscopy is not done as a screening test.…”